Healthcare Worker Mental Health in COVID-19

How COVID-19 Has Affected the Mental Health of Healthcare Workers

Background

  • "The COVID-19 pandemic has had an unprecendented impact on health systems in most countries, and in particular, on the mental health and well-being of health workers on the frontline of pandemic response efforts."[1]
  • Feelings of grief, hopelessness, isolation, distress, and burnout are common during the COVID-19 pandemic[2]
  • Some contributing factors for healthcare workers developing mental health concerns during COVID-19 include
    • Chronic uncertainty and stress; frequent shifts in schedules and routines; social stigma and isolation; losing patients and loved ones; lack of PPE; compromising quality and safety of care; breaching of protocols and guidelines; increased risk of becoming infected and fear of transmitting virus to loved ones; lack of resources
  • The WHO has issued an urgent call for tailored and culturally sensitive mental health interventions for frontline healthcare workers during the COVID-19 pandemic[3]

What Research Says

  • Healthcare workers on the frontline who are directly working in the diagnosis, treatment, and care of COVID-19 patients are at-risk for developing psychiatric distress and other mental health symptoms[4]
  • The most common psychiatric disorders diagnosed in frontline healthcare workers during epidemics include PTSD, anxiety, and depression[5]
  • Sleeping disorders, insomnia, moral injury, and burnout are also common[1]
  • One study indicated that 43% of frontline healthcare workers experience somatic symptoms i.e. headaches, chest pain, and lethargy, linked to stress[6]
  • According to one study, "Most (62%) frontline health care workers say that worry and stress related to the pandemic has negatively affected their mental health, the survey of all frontline health care workers shows. At least 4 in 10 frontline health care workers say that the pandemic has negatively impacted their physical health (49%), and their relationships with family members (42%) and coworkers (41%). Sizeable shares report experiencing sleep-related problems (47%), frequent headaches or stomachaches (31%), and increased alcohol or drug use (16%) that they attribute to pandemic-related worry and stress. More than half (56%) report experiencing at least one of these three issues."[7]
  • A recent systemic review and meta analysis across 65 studies, including 97,333 health care workers in 21 countries has identified a high prevalence of moderate depression (21.7%) anxiety (22.1%) and PTSD (21.5%) among health care workers during the COVID-19 pandemic.[8]

What this means for YOU as a Healthcare Worker

  • If your mental health (and potentially physical health) has been affected by the COVID-19 pandemic, you are not alone
  • This is a normal response to an abnormal situation/public health crisis
  • You likely know others at your place of employment who are experiencing similar mental health concerns
  • If work is starting to take a toll, and impacting different areas of your life, find out what might be helpful for you (see below!)
  • Many different interventions can be available and helpful for you, depending on your individualized needs
  • Whether by learning about coping skills on your own, to getting support from supervisors or colleagues, or speaking with a mental health professional, there are things that can help you navigate the COVID-19 pandemic - both professionally and personally!

Advocating for the Mental Health of Healthcare Workers

See Advocacy, Needs, and Further Action Needed

Flowchart: Assess Your Needs as a Healthcare Worker

This flowchart will allow you to identify the most appropriate way to handle your COVID-19 related mental health concerns, based on your self-identified level of need

Loosely based on the COVID-19 Four-Tier Interventional Model from the Department of Psychiatry and Human Behavior and HR at Sidney Kimmel Medical College[9]

Mental Health in COVID-19

References

  1. Søvold LE, Naslund JA, Kousoulis AA, et al. Prioritizing the Mental Health and Well-Being of Healthcare Workers: An Urgent Global Public Health Priority. Front Public Health. 2021;9:679397.  [PMID:34026720]
  2. Liberati, E., Richards, N., Willars, J. et al. A qualitative study of experiences of NHS mental healthcare workers during the Covid-19 pandemic. BMC Psychiatry 21, 250 (2021). https://doi.org/10.1186/s12888-021-03261-8
  3. Buselli R, Corsi M, Veltri A, et al. Mental health of Health Care Workers (HCWs): a review of organizational interventions put in place by local institutions to cope with new psychosocial challenges resulting from COVID-19. Psychiatry Res. 2021;299:113847.  [PMID:33721785]
  4. Elkholy H, Tawfik F, Ibrahim I, et al. Mental health of frontline healthcare workers exposed to COVID-19 in Egypt: A call for action. Int J Soc Psychiatry. 2021;67(5):522-531.  [PMID:32972298]
  5. Cabarkapa S, Nadjidai SE, Murgier J, et al. The psychological impact of COVID-19 and other viral epidemics on frontline healthcare workers and ways to address it: A rapid systematic review. Brain Behav Immun Health. 2020;8:100144.  [PMID:32959031]
  6. Hong S, Ai M, Xu X, et al. Immediate psychological impact on nurses working at 42 government-designated hospitals during COVID-19 outbreak in China: A cross-sectional study. Nurs Outlook. 2021;69(1):6-12.  [PMID:32919788]
  7. Paloski, C. Post Survey Reveals the Serious Mental Health Challenges Facing Frontline Health Care Workers a Year into the COVID-19 Pandemic. KFF. 2021. https://www.kff.org/coronavirus-covid-19/press-release/kff-post-survey-rev... Accessed November 2, 2021.
  8. Li Y, Scherer N, Felix L, et al. Prevalence of depression, anxiety and post-traumatic stress disorder in health care workers during the COVID-19 pandemic: A systematic review and meta-analysis. PLoS One. 2021;16(3):e0246454.  [PMID:33690641]
  9. O’Hayer C, Nobleza D, Inch S, et al. Behavioral health for the front line: Lessons from the COVID-19 pandemic. NEJM Catalyst Innovations in Care Delivery. 2021; 2(7): http://doi.org/10.1056/CAT.21.0109



Last updated: November 11, 2021
Mental Health in COVID-19

This flowchart is designed to help determine the best path for you, so that you can navigate your COVID-19-related mental health concerns in an effective and helpful manner.

This is considered self-referral, or in some cases, referral needs to be made by department supports.  

Are you seeking:

A. Education

B. Support

Please select the option that sounds most like you:

A: I want to learn how to be healthy and maintain my mental health during difficult times, on an individual basis

B: I have work-related stress and prefer to talk with my supervisor or coworkers in order to get reassurance or practical help

C: I am experiencing work-related stress and other forms of stress and speaking to those with similar experiences would help

D: I am having a hard time coping and it is interrupting areas of my life, including work performance and relationships.  Speaking with a professional would help.  

 

Are you at work?

Is this an emergency or are you in crisis?

This is considered one-on-one reassurance and practical help.

Would you rather talk with:

A. Your Supervisor

B.  Colleagues or Coworkers

This is considered early intervention and self-help support.

Are you seeking information on COVID-19, testing, and  vaccines, or are you seeking to learn coping tools?

 

Notify your Supervisor immediately.

It is your supervisor's job to be looking out for you and your well-being as a frontline healthcare worker. 

They should be able to connect you with appropriate services, and can assist with managing crises

Call any of the below numbers for immediate support

911

The National Suicide Prevention Hotline (800) 273-8255

The SAMHSA Disaster Distress Hotline (800)

Feel free to peruse the internet to find print, audio, or video resources which may be most helpful for your personal experience.

Want to learn to cope with COVID-19 related mental health concerns using an app?

See COVID-19 Apps for Coping.

Some suggestions - 

  • Call/talk with your loved ones
  • Journal about your experiences
  • Take a break!
  • Write words of affirmation to yourself and carry with you in your pocket
  • Utilize grounding techniques focused on your five senses
  • What healthy things do you enjoy doing (i.e. exercise, hobbies)?

See Coping with COVID-19 on an Individual Basis, without Apps

Unbound Medicine has a wide variety of COVID-19 information available.

Other sources of information on COVID-19:

The Centers for Disease Control and Prevention (CDC) is the United States' health protection agency.

The World Health Organization (WHO) is a United Nations agency whose responsibility is international public health

See Information on COVID-19

This is considered to be the time to seek professional help as soon as possible.  

Mental health professionals are the most qualified to help you navigate concerning or distressing mental health symptoms and issues.  

Options can include, but are not limited to, engaging in Employee Assistance Program (EAP) offerings or individual counseling sessions

See Professional Mental Health Services for COVID-19 Healthcare Workers

Supervisors should be able to help trouble-shoot specific situations or circumstances which may be affecting you, which may not be appropriate to discuss with coworkers. 

Ask for information, share concerns, discuss need for resources, and process events.  

See Reassurance and Practical Help in the COVID-19 Workplace 

Close colleagues are often the first to notice when other colleagues are struggling. 

Speak with your coworkers and gain their support, discuss team-building opportunities, or ask for input on handling stress.

See Reassurance and Practical Help in the COVID-19 Workplace

Classes can sometimes be offered in the workplace to teach effective coping skills while also allowing for opportunities to de-stress with your colleagues.  

Ask your manager or supervisor about availability of offerings, or ability to implement these types of programs.  

See Peer Education and Support During COVID-19

Peer support can be beneficial for improving mental health during COVID-19

Change of shift support groups and unit-wide processing sessions can boost morale and build relationships

Confidential peer-to-peer hotlines can sometimes be available. 

Ask your manager or supervisor about availability of offerings, or ability to implement these types of programs.  

In addition, online support programs and apps can also be helpful for engaging in peer support during the pandemc.

See Peer Education and Support During COVID-19

Mental_Health_in_COVID_19Mental Health in COVID-192036->2050A2036->2051B2035->2036C2035->2037B2035->2038A2035->2047D2034->2039Yes2034->2040No2033->2035No2033->2034Yes2037->2048A2037->2049B2038->2041Coping Tools2038->2044Covid Information2041->2042Yes2041->2043No

This is considered self-referral, or in some cases, referral needs to be made by department supports.  

Are you seeking:

A. Education

B. Support

Classes can sometimes be offered in the workplace to teach effective coping skills while also allowing for opportunities to de-stress with your colleagues.  

Ask your manager or supervisor about availability of offerings, or ability to implement these types of programs.  

See Peer Education and Support During COVID-19

Peer support can be beneficial for improving mental health during COVID-19

Change of shift support groups and unit-wide processing sessions can boost morale and build relationships

Confidential peer-to-peer hotlines can sometimes be available. 

Ask your manager or supervisor about availability of offerings, or ability to implement these types of programs.  

In addition, online support programs and apps can also be helpful for engaging in peer support during the pandemc.

See Peer Education and Support During COVID-19

Please select the option that sounds most like you:

A: I want to learn how to be healthy and maintain my mental health during difficult times, on an individual basis

B: I have work-related stress and prefer to talk with my supervisor or coworkers in order to get reassurance or practical help

C: I am experiencing work-related stress and other forms of stress and speaking to those with similar experiences would help

D: I am having a hard time coping and it is interrupting areas of my life, including work performance and relationships.  Speaking with a professional would help.  

 

This is considered one-on-one reassurance and practical help.

Would you rather talk with:

A. Your Supervisor

B.  Colleagues or Coworkers

This is considered early intervention and self-help support.

Are you seeking information on COVID-19, testing, and  vaccines, or are you seeking to learn coping tools?

 

This is considered to be the time to seek professional help as soon as possible.  

Mental health professionals are the most qualified to help you navigate concerning or distressing mental health symptoms and issues.  

Options can include, but are not limited to, engaging in Employee Assistance Program (EAP) offerings or individual counseling sessions

See Professional Mental Health Services for COVID-19 Healthcare Workers

Are you at work?

Notify your Supervisor immediately.

It is your supervisor's job to be looking out for you and your well-being as a frontline healthcare worker. 

They should be able to connect you with appropriate services, and can assist with managing crises

Call any of the below numbers for immediate support

911

The National Suicide Prevention Hotline (800) 273-8255

The SAMHSA Disaster Distress Hotline (800)

Is this an emergency or are you in crisis?

Supervisors should be able to help trouble-shoot specific situations or circumstances which may be affecting you, which may not be appropriate to discuss with coworkers. 

Ask for information, share concerns, discuss need for resources, and process events.  

See Reassurance and Practical Help in the COVID-19 Workplace 

Close colleagues are often the first to notice when other colleagues are struggling. 

Speak with your coworkers and gain their support, discuss team-building opportunities, or ask for input on handling stress.

See Reassurance and Practical Help in the COVID-19 Workplace

Feel free to peruse the internet to find print, audio, or video resources which may be most helpful for your personal experience.

Want to learn to cope with COVID-19 related mental health concerns using an app?

Unbound Medicine has a wide variety of COVID-19 information available.

Other sources of information on COVID-19:

The Centers for Disease Control and Prevention (CDC) is the United States' health protection agency.

The World Health Organization (WHO) is a United Nations agency whose responsibility is international public health

See Information on COVID-19

Some suggestions - 

  • Call/talk with your loved ones
  • Journal about your experiences
  • Take a break!
  • Write words of affirmation to yourself and carry with you in your pocket
  • Utilize grounding techniques focused on your five senses
  • What healthy things do you enjoy doing (i.e. exercise, hobbies)?

See Coping with COVID-19 on an Individual Basis, without Apps